Provider Demographics
NPI:1801625736
Name:DWYER, LAUREN A (MSED)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:A
Last Name:DWYER
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:A
Other - Last Name:VAN BOURGONDIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:165 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:THORNWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:10594-1217
Mailing Address - Country:US
Mailing Address - Phone:914-438-2569
Mailing Address - Fax:
Practice Address - Street 1:17 INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10606-1613
Practice Address - Country:US
Practice Address - Phone:914-946-9559
Practice Address - Fax:914-946-9538
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator